Antibiotic choice for diabetic foot syndrome. Diabetic nephropathy: symptoms, stages and treatment Diabetic nephropathy is treated with

Diabetic nephropathy (or diabetic kidney disease) is a chronic complication of diabetes. The risk of kidney damage in diabetic patients is 12-17 times higher than in healthy people.

Diabetic nephropathy is a structural and functional disorder of the kidneys caused directly by hyperglycemia (high blood sugar) during diabetes. Like all complications of diabetes, nephropathy is the result of a lack of compensation.

Other factors contributing to the development of complications include:

• long-term diabetes
• male,
• high blood pressure,
• high concentration of lipids in the blood (cholesterol and triglycerides),
• smoking,
• excessive amount of protein in the diet.

Excess protein can increase glomerular filtration rate and accelerate the onset of diabetic nephropathy. Diabetic patients should not follow protein-rich diets (where protein exceeds 20% of daily caloric requirements), such as the Atkins or South Beach diet.

The beginning of diabetic nephropathy is indicated by excessive excretion of albumin in the urine. It is a low molecular weight protein found in urine in healthy individuals in small amounts.

Diabetes causes changes in the glomeruli of the kidneys, which lead to increased permeability of the small blood vessels of the glomeruli, which causes the transfer of albumin from the blood into the urine, where it appears in large quantities.

Read more about kidney damage from diabetes in the materials that I have collected on the net.

Diabetic nephropathy is a complication of diabetes mellitus caused by damage to blood vessels in the kidneys. In the early stages, its development cannot be felt in any way. The earliest marker of developing diabetic nephropathy is microalbuminuria - excretion of albumin in the urine in small amounts, not detected by conventional methods of studying protein in the urine.

With the progression of nephropathy, the protein content in the urine is detected by conventional diagnostic methods (urinalysis, daily proteinuria). The appearance of proteinuria indicates a loss of functional ability (sclerosis) of 50-70% of the renal glomeruli, while there is an increase in blood pressure (BP) and a decrease in glomerular filtration rate. Therefore, each patient with diabetes mellitus should have a urine test at least once a year to detect microalbuminuria.

When does it start to develop?

In type 1 diabetes mellitus, the first sign of nephropathy, microalbuminuria, usually appears 5-10 years after the onset of diabetes mellitus. In some patients, microalbuminuria appears earlier. In 20-30% of people with type 2 diabetes, microalbuminuria is detected already at diagnosis.

This is due to the fact that type 2 diabetes mellitus is asymptomatic for a long time, and it is rather difficult to establish the true time of its onset. In addition, many patients with type 2 diabetes have other conditions that can lead to changes in the kidneys (arterial hypertension, atherosclerosis, heart failure, high uric acid levels, etc.).

What level of albumin in urine is considered normal? What is micro- and macroalbuminuria?

What is the glomerular filtration rate, how is it determined, what is it normal?

The most important indicator of kidney function is the glomerular filtration rate (GFR). GFR is understood as the rate of filtration of water and low molecular weight components of blood plasma through the glomeruli of the kidneys per unit of time. GFR is determined using calculation formulas for blood creatinine levels (CKD-EPI, Cockcroft-Gault, MDRD, etc.).

In some cases, the Rehberg test (determination of the level of creatinine in the blood and in urine collected over a certain period of time) is used to determine GFR. The GFR value refers to the standard body surface area. Normal GFR is ≥90 ml/min/1.73m2. A decrease in glomerular filtration indicates a decrease in kidney function.

What is Chronic Kidney Disease?

A decrease in glomerular filtration rate is manifested by symptoms of chronic renal failure, regardless of the cause of the disease. Currently, instead of the term "renal failure", the term "chronic kidney disease" is more often used.

Chronic kidney disease - signs of kidney damage (such as changes in urine tests) and/or decreased kidney function for three or more months.

There are 5 stages of chronic kidney disease depending on the level of GFR:

What are the manifestations of chronic kidney disease?

The initial stages of chronic kidney disease are usually asymptomatic. Before others, complaints of loss of appetite, dryness and unpleasant taste in the mouth, fatigue are noted. There may be an increase in the volume of urine released (polyuria), frequent nighttime urination. Changes in the analyzes can reveal anemia, a decrease in the specific gravity of urine, an increase in the level of creatinine, blood urea, changes in fat metabolism.

In the later stages of chronic kidney disease (4th and 5th), there is pruritus, loss of appetite, often nausea and vomiting. As a rule, there are edema and severe arterial hypertension.

What is the treatment?

Diagnosis and treatment of diabetic nephropathy is carried out by an endocrinologist or therapist. Starting from the 3rd stage of chronic kidney disease, a consultation with a nephrologist is necessary. Patients with stage 4-5 chronic kidney disease should be constantly monitored by a nephrologist.

If microalbuminuria or proteinuria is detected, drugs are prescribed that block the formation or action of angiotensin II. Angiotensin II has a powerful vasoconstrictive effect, contributes to the development of fibrosis and a decrease in kidney function.

Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers can reduce the effect of angiotensin II. The choice of drug and dose is the prerogative of the doctor. Long-term use of the drug of this class delays the development of changes in the kidneys in diabetic nephropathy.

The most important treatments for diabetic nephropathy are:

• blood sugar correction
• correction of blood pressure and lipids (fats) in the blood.

Target blood glucose levels in diabetic patients with different stages of chronic kidney disease are set individually by the attending physician.
Target blood pressure for patients with diabetes:<130/80 мм рт. ст.

Target values ​​of blood cholesterol:<5,2 ммоль/л, а при наличии сердечно-сосудистых заболеваний <4,8 ммоль/л. Целевой уровень триглицеридов: <1,7 ммоль/л.

What is renal replacement therapy?

With a decrease in the glomerular filtration rate below 15 ml / min / m2, the issue of starting renal replacement therapy is decided. There are three types of renal replacement therapy:

• hemodialysis,
• peritoneal dialysis,
• kidney transplant.

Hemodialysis is a method of blood purification using an artificial kidney machine. To ensure it, the patient undergoes a small surgical intervention to provide vascular access: the imposition of an arteriovenous fistula on the forearm, as a rule, 2-3 months before the start of RRT. Hemodialysis procedures are carried out 3 times a week for 4 hours in a hemodialysis department.

Attention!

Peritoneal dialysis is the process of cleansing the blood through the peritoneum by injecting dialysate into the abdominal cavity 3-5 times a day, 7 days a week. A peritoneal catheter is inserted into the abdominal cavity to ensure the exchange of dialysis fluid. Procedures are carried out at home.

Kidney transplantation - transplantation of a donor kidney (related or cadaveric) in the iliac region. In order to prevent transplant rejection, patients should take drugs that suppress the immune system. In some centers, type 1 diabetics with end-stage renal disease receive a kidney and pancreas transplant at the same time.

Does chronic kidney disease affect the need for insulin and glucose-lowering drugs?

A change in the need for insulin in patients with diabetes mellitus, as a rule, occurs with a decrease in the glomerular filtration rate.<30 мл/мин/1,73 м2. Потребность в инсулине, как правило, снижается из-за удлинения периода выведения инсулина из крови. Скорость снижения потребности в инсулине может измеряться несколькими единицами в день. Это диктует необходимость коррекции доз инсулина во избежание развития .

In patients with type 2 diabetes mellitus with a decrease in glomerular filtration rate<60 мл/мин/1,73 м2 может возникнуть потребность в замене сахароснижающего препарата. Это связано с тем, что многие лекарственные препараты выводятся через почки и могут накапливаться при почечной недостаточности.

What are the target values ​​of glycemia in patients?

Most people with severe manifestations of diabetic nephropathy have impaired recognition, as well as reduced secretion of contrainsular hormones in response to hypoglycemia. With this in mind, not all people with diabetes and kidney damage should achieve normoglycemia. Blood sugar targets for patients with kidney failure are set individually.

How to prevent the development of the disease?

The most important methods for preventing the development of kidney damage in diabetes mellitus are:

• Achieve optimal blood sugar control
• Maintaining blood pressure at the target level:<130/80 мм рт. ст.
• Correction of dyslipidemia (cholesterol and triglyceride levels in the blood).

Source: http://niikelsoramn.ru/dlja-pacientov/diabet-nefropatija/

Diabetic nephropathy - where does it come from?

Nephropathy is a disease in which the functioning of the kidneys is impaired. Diabetic nephropathy is kidney damage that develops as a result of diabetes mellitus. Damage to the kidneys consists in sclerosis of the kidney tissues, which leads to the loss of efficiency by the kidneys.

It is one of the most frequent and dangerous complications of diabetes. It occurs in insulin-dependent (in 40% of cases) and non-insulin-dependent (20-25% of cases) types of diabetes mellitus.

A feature of diabetic nephropathy is its gradual and almost asymptomatic development. The first phases of the development of the disease do not cause any discomfort, therefore, most often they turn to the doctor already in the last stages of diabetic nephropathy, when it is almost impossible to cure the changes that have occurred. That is why, an important task is the timely examination and detection of the first signs of diabetic nephropathy.

Reasons for development

The main reason for the development of diabetic nephropathy is the decompensation of diabetes mellitus -. The consequence of hyperglycemia is high blood pressure, which also adversely affects the functioning of the kidneys.

With high sugar and high blood pressure, the kidneys cannot function normally, and substances that should be removed by the kidneys eventually accumulate in the body and cause poisoning. Increases the risk of developing diabetic nephropathy and a hereditary factor - if the parents had, then the risk increases.

stages

There are five main stages in the development of diabetic nephropathy:

1. It develops at the onset of diabetes mellitus. It is characterized by an increase in glomerular filtration rate (GFR) over 140 ml/min, an increase in renal blood flow (PC) and normoalbuminuria.
2. It develops with a small experience of diabetes (no more than five years). At this stage, initial changes in the renal tissue are observed. It is characterized by normoalbuminuria, increased glomerular filtration rate, thickening of basement membranes and glomerular mesangium.
3. It develops with the experience of diabetes from five to 15 years. It is characterized by a periodic increase in blood pressure, increased or normal glomerular filtration rate and microalbuminuria.
4. Stage of severe nephropathy. It is characterized by normal or reduced glomerular filtration rate, arterial hypertension and proteinuria.
5. It develops with a long history of diabetes (more than 20 years). It is characterized by a reduced glomerular filtration rate, arterial hypertension. At this stage, a person experiences symptoms of intoxication.

It is very important to identify developing diabetic nephropathy in the first three stages, when treatment of changes is still possible. In the future, it will not be possible to completely cure changes in the kidneys, it will only be possible to support from further deterioration.

Diagnostics

Timely diagnosis of diabetic nephropathy is of great importance. It is important to detect initial changes in the early stages. The main criterion for determining the degree of change in the early stages is the amount of albumin excreted in the urine - albuminuria.

• Normally, a person releases less than 30 mg of albumin per day, this condition is called normoalbuminuria.
• With an increase in the release of albumin to 300 mg per day, microalbuminuria is isolated.
• With the release of albumin over 300 mg per day, macroalbuminuria occurs.

Persistent microalbuminuria indicates the development of diabetic nephropathy in the next few years.

It is necessary to regularly take a urine test to determine the protein in order to track changes. With the frequent presence of albumin in a single portion of urine, it is necessary to pass a daily urine test. If a protein is found in it at a concentration of 30 mg and the same results are revealed in repeated analyzes of daily urine (in two and three months), then the initial stage of diabetic nephropathy is set. At home, you can also monitor the amount of protein secreted using special visual test strips.

In the later stages of the development of diabetic nephropathy, the main criterion is proteinuria (more than 3 g / day), a decrease in glomerular filtration rate, and an increase in arterial hypertension. From the moment of development of abundant proteinuria, no more than 7-8 years will pass before the development of the terminal stage of diabetic nephropathy.

Treatment

In the early reversible stages of the disease, it is possible to do without serious drugs. Of great importance is the compensation of diabetes. Sudden spikes in sugar and prolonged hyperglycemia should not be allowed. It is necessary to normalize the pressure. Take measures to improve microcirculation and prevent atherosclerosis (reduce blood cholesterol, stop smoking).

In the later stages, it is necessary to take medication, follow a special low-protein diet, and, of course, normalize sugar and blood pressure. In the later stages of kidney failure, the need for insulin decreases. You have to be very careful to avoid hypoglycemia.

Patients with insulin-independent insulin with the development of renal failure are transferred to insulin therapy. This is due to the fact that all oral hypoglycemic drugs are metabolized in the kidneys (with the exception of Glurenorm, its use is possible in renal failure). With increased creatine (from 500 µmol / l and above), there is a question about hemodialysis or kidney transplantation.

Prevention

To prevent the development of diabetic nephropathy, certain rules must be observed:

• normalization of blood glucose. It is important to constantly maintain the level of sugar within the normal range. In those cases with non-insulin-dependent diabetes, when the diet does not give the desired results, a transfer to insulin therapy is necessary.
• normalization of blood pressure with the help of antihypertensive therapy when the pressure rises above 140/90 mm Hg.
• adherence to a low-protein diet in the presence of proteinuria (reducing the intake of protein of animal origin).
• following a low-carbohydrate diet. It is necessary to keep the level of triglycerides (1.7 mmol/l) and cholesterol (no more than 5.2 mmol/l) within the normal range. If the diet is ineffective, it is necessary to take medications, the action of which is aimed at normalizing the lipid composition of the blood.

Source: https://diabet-life.ru/diabeticheskaya-nefropatiya/

Diabetic nephropathy is a serious complication of diabetes.

Diabetic nephropathy is a bilateral lesion of the kidneys, leading to a decrease in functional ability, and arising due to the influence of various pathological effects that form in diabetes mellitus. This is one of the most formidable complications of diabetes mellitus, which largely determines the prognosis of the underlying disease.

It should be said that diabetic nephropathy in type I diabetes mellitus develops more often than in type II diabetes. However, type II diabetes is more common. A characteristic feature is the slow development of kidney pathology, and the duration of the underlying disease (diabetes mellitus) plays an important role.

Causes

First, it must be said that the development of DN does not have a direct correlation with the level of blood glucose, and in some cases, diabetes mellitus does not develop at all. To date, there is no unambiguous opinion about the mechanism for the development of ND, but the main theories are:

1. metabolic theory. Long-term hyperglycemia (high blood glucose) leads to various kinds of biochemical disorders (increased production of glycated proteins, direct toxic effect of high glucose levels, biochemical disorders in capillaries, polyol pathway of glucose metabolism, hyperlipidemia), which have a damaging effect on the renal tissue.
2. hemodynamic theory. Diabetic nephropathy develops as a result of impaired intrarenal blood flow (intraglomerular hypertension). At the same time, hyperfiltration initially develops (accelerated formation of primary urine in the renal glomeruli, with the release of proteins), but then the connective tissue grows with a decrease in filtration capacity.
3. genetic theory. This theory is based on the primary presence of genetically determined predisposing factors that are actively manifested under the influence of metabolic and hemodynamic disorders characteristic of diabetes mellitus.

Apparently, in the development of DN, all three mechanisms take place; moreover, they are interconnected by the type of formation of vicious circles.

Symptoms

The pathology is slowly progressive, and the symptoms depend on the stage of the disease. The following stages are distinguished:

• Asymptomatic stage - there are no clinical manifestations, however, an increase in the glomerular filtration rate indicates the beginning of a violation of the activity of the renal tissue. There may be an increase in renal blood flow and renal hypertrophy. The level of microalbumin in urine does not exceed 30 mg/day.
• The stage of initial structural changes - the first changes in the structure of the renal glomeruli appear (thickening of the capillary wall, expansion of the mesangium). The level of microalbumin does not exceed the norm (30 mg/day) and there is still an increased blood flow in the kidney and, accordingly, increased glomerular filtration.
• Prenephrotic stage - the level of microalbumin exceeds the norm (30-300 mg / day), but does not reach the level of proteinuria (or episodes of proteinuria are minor and short), blood flow and glomerular filtration are usually normal, but may be increased. There may already be episodes of high blood pressure.
• Nephrotic stage - proteinuria (protein in the urine) becomes permanent. Periodically, hematuria (blood in the urine) and cylindruria may occur. Renal blood flow and glomerular filtration rate decrease. Arterial hypertension (increased blood pressure) becomes persistent. Edema joins, anemia appears, a number of blood parameters increase: ESR, cholesterol, alpha-2 and beta globulins, beta-lipoproteins. Creatinine and urea levels are slightly elevated or within normal limits.
• Nephrosclerotic stage (uremic) - the filtration and concentration functions of the kidneys are sharply reduced, which leads to a pronounced increase in the level of urea and creatinine in the blood. The amount of blood protein is significantly reduced - pronounced edema is formed. In the urine, proteinuria (protein in the urine), hematuria (blood in the urine), cylindruria are detected. Anemia becomes pronounced. Arterial hypertension is persistent, and the pressure reaches high numbers. At this stage, despite the high numbers of blood glucose, sugar in the urine is not detected. Surprisingly, at the nephrosclerotic stage of diabetic nephropathy, the rate of degradation of endogenous insulin decreases, and the excretion of insulin in the urine also stops. As a result, the need for exogenous insulin is reduced. Blood glucose levels may drop. This stage ends with chronic renal failure.

Diagnostics

Ideally, diabetic nephropathy should be detected early. Early diagnosis is based on monitoring the level of microalbumin in the urine. Normally, the content of microalbumin in the urine should not exceed 30 mg / day. Exceeding this threshold indicates the initial stage of the pathological process. If microalbuminuria becomes permanent, this indicates a relatively rapid development of severe DN.

Another early marker of diabetic nephropathy is the determination of renal filtration. For this purpose, the Reberg test is used, which is based on the determination of creatinine in daily urine.

In the later stages, diagnosis is not difficult and is based on the identification of the following changes:

• Proteinuria (protein in the urine).
• Decreased glomerular filtration rate.
• An increase in the levels of creatinine and urea in the blood (azotemia).
• Arterial hypertension.

Perhaps the development of nephrotic syndrome, accompanied by severe proteinuria (protein in the urine), hypoproteinemia (decrease in blood protein), edema. When diagnosing diabetic nephropathy, it is very important to make a differential diagnosis with other diseases that can lead to similar changes in the analyzes:

• Chronic pyelonephritis. Distinctive features are the presence of a characteristic clinical picture, leukocyturia, bacteriuria, a characteristic picture on ultrasound and excretory urography.
• Tuberculosis of the kidneys. Distinctive features: the absence of flora growth in the presence of leukocyturia, the detection of Mycobacterium tuberculosis in the urine, a characteristic picture with excretory urography.
• Acute and chronic glomerulonephritis.

In some cases, a kidney biopsy is performed to clarify the diagnosis. Here are some indications for a diagnostic kidney biopsy:

• The development of proteinuria earlier than 5 years after the development of type I diabetes.
• Rapid increase in proteinuria or sudden development of nephrotic syndrome.
• Persistent micro- or macrohematuria.
• The absence of damage to other organs and systems characteristic of diabetes mellitus.

Prevention of diabetic nephropathy should begin as early as possible, namely from the first day of diabetic diagnosis. The basis of prevention is the control of blood glucose levels, metabolic disorders. An important indicator is the level of glycated hemoglobin, which indicates the quality of correction of glucose levels.

As a prophylaxis, ACE inhibitors should be prescribed (they lower blood pressure, and also eliminate intraglomerular filtration), even with normal blood pressure numbers.

Treatment

The transition from prevention to treatment should occur during the formation of the prenephrotic stage (Stage III):

• Diet (limiting the intake of animal proteins).
• ACE inhibitors.
• Correction of dyslipidemia.

Treatment of diabetic nephropathy in stage IV (nephrotic):

• Low protein diet.
• Salt free diet.
• ACE inhibitors.
• Correction of hyperlipidemia (low-fat diet, drugs that normalize blood lipid spectrum: simvastin, nicotinic acid, probucol, lipoic acid, finofibrate…)

Due to the fact that with the development of stage IV DN, hypoglycemia (decrease in blood glucose levels) can develop, blood glucose control should be more carefully approached, and often it is necessary to abandon the maximum compensation of blood glucose (due to the likelihood of hypoglycemia).

At the fifth stage, the above therapeutic measures are joined by:

• Normalization of hemoglobin levels (erythropoietin).
• Prevention of osteoporosis (vitamin D3).
• Addressing the issue of hemodialysis, peritoneal dialysis and kidney transplantation.

Source: http://www.urolog-site.ru/slovar/d/diabeticheskaja.html

Diabetic nephropathy - how to treat?

According to WHO, one of the most common diseases of our time is diabetes mellitus. Today, this disease is gaining new momentum, and the victory over it is not yet on the side of medical science. Diabetes is a disease that almost everyone has heard of.

And very often the life of people suffering from this disease is complicated not only by the need to constantly monitor the level of glucose in the blood, but also by serious damage to various organs and systems, while the kidneys are no exception.

One of the most serious complications of diabetes is diabetic nephropathy. Naturally, diabetes is by no means the only reason for the development of a pathological process in the kidneys. But among the people standing in line for a kidney transplant, the majority are diabetics.

Diabetic nephropathy is a very dangerous condition leading to end-stage renal disease. Therefore, it is so important for people with diabetes to have regular monitoring not only by an endocrinologist, but also by a nephrologist.

Causes of nephropathy

Diabetic nephropathy is a specific lesion of the tubular and glomerular apparatus of the kidneys (filter elements) and the vessels that feed them. This is perhaps the most dangerous diabetic complication, which is more common with and has several stages of development.

Nephropathy does not develop in every patient with diabetes mellitus, and, given this fact, experts put forward the following theories about the mechanisms for the development of this complication:

• genetic predisposition,
• violation of hemodynamics in the kidneys,
• metabolic disorders.

As practice shows, in most cases of development of diabetic nephropathy, a combination of all three causes is observed. The main provoking factors for the development of nephropathy are:

• sustained rise in blood sugar
• elevated levels of triglycerides and cholesterol in the blood,
• arterial hypertension,
• anemia,
• smoking.

Diabetes can have a damaging effect on the kidneys for many years, without causing any negative sensations. It is very important to detect the development of diabetic nephropathy as early as possible, even at an asymptomatic stage, because if the clinical signs of the disease begin to manifest themselves, this already indicates the presence of renal failure, which is much more difficult to treat.

Symptoms

The main danger of nephropathy is that for many years the disease has an asymptomatic course and does not manifest itself in any way. Symptoms of the disease occur already at the stage of development of renal failure. The severity of the clinical picture, laboratory parameters and patient complaints completely depend on the stage of the disease:

• Asymptomatic stage - a person does not feel any physical changes, but the first changes are visible in the urine - the glomerular filtration rate increases, microalbuminuria develops (albumin levels increase).
• The stage of initial changes - there are no physical complaints, serious changes begin to occur in the kidneys - the walls of the vessels that feed the glomerular apparatus thicken, proteinuria develops, and the level of albumin rises.
• Beginning nephropathy, or prenephrotic stage - periodically increases blood pressure, several times the glomerular filtration rate increases, there is a high level of albumin.
• Severe diabetic nephropathy or nephrotic stage - symptoms of nephrotic syndrome appear: a regular increase in blood pressure, edema, in the analyzes - proteinuria (protein in the urine), microhematuria, anemia, increased ESR, urea and creatinine above normal.
• Uremic stage or terminal renal failure - a steady increase in blood pressure, persistent edema, headaches, general weakness,. In the analyzes - a significant decrease in the glomerular filtration rate, the level of urea and creatinine is sharply increased, in the urine - high levels of protein. At the same time, there is no sugar in urine tests, because the kidneys stop excreting insulin.

The end stage of diabetic nephropathy is life-threatening, and the only treatment at this stage is hemodialysis and kidney transplantation.

Diagnostics

When diagnosing diabetic nephropathy, a specialist must accurately determine whether kidney damage is caused by diabetes mellitus or other causes, therefore, a differential diagnosis with chronic pyelonephritis, kidney tuberculosis and glomerulonephritis is mandatory.

To diagnose diabetic nephropathy, the Clinic of Modern Medicine uses all the necessary laboratory and instrumental research methods:

• blood tests, urine;
• Ultrasound, MRI of the kidneys;
• overview, excretory urography;
• kidney biopsy.

Simple tests do not accurately diagnose the pre-clinical stage of the disease; in our Clinic, patients with diabetes undergo special tests to determine albumin and glomerular filtration rate. An increase in glomerular filtration rate and an increase in albumin levels indicate an increase in pressure in the renal vessels, which is a sign of diabetic nephropathy.

Source: http://www.ksmed.ru/uslugi/nefrologiya/zabolevaniya/diabeticheskaya-nefropatiya/

Diabetic nephropathy - curbing the disease

In diabetic nephropathy, kidney damage occurs. One of the frequent long-term complications of diabetes mellitus, both 1 and. According to statistics, diabetic nephropathy occurs in 40% of patients with diabetes, but with adequate treatment and control of blood glucose and blood pressure, its development can be prevented.

As you know, in diabetes mellitus, as a result of prolonged uncontrolled hyperglycemia, small arteries are affected, including the arteries that supply the kidney with blood.

What is diabetic nephropathy

Nephropathy is a term for impaired kidney function. At the last stage of this complication, renal failure occurs - a condition in which the kidneys practically cease to perform their filtration function. If a patient has diabetes mellitus that is difficult to treat or there is no proper control of blood sugar levels, then damage to small vessels gradually develops - microangiopathy.

Attention!

Diabetic nephropathy occurs in patients with type 1 and type 2 diabetes. This disease has several stages of development. In the last, fifth stage, kidney dysfunction (CRF) occurs, and the patient may need a procedure such as hemodialysis. In the early stages of diabetic nephropathy, there may be no symptoms.

Manifestations

Symptoms of diabetic nephropathy usually become noticeable in the later stages. With nephropathy, the penetration of protein through the kidneys into the urine occurs. Normally, this occurs only with high fever, heavy physical activity, pregnancy, or infection.

Not every patient with diabetes develops nephropathy. The kidneys perform a filtering function. In the case of nephropathy, their function suffers. Therefore, protein is found in the urine, in addition, such patients have high blood pressure and elevated blood cholesterol levels.

In the case when nephropathy reaches a late stage, the patient may experience:

With severe diabetic nephropathy, blood sugar levels may drop because the kidneys cannot filter insulin and other sugar-lowering drugs.

That is why, in order to prevent late forms of diabetic nephropathy and slow down this process, it is necessary to regularly examine kidney function once a year using biochemical analyzes.

Cause

According to statistics, the development of diabetic nephropathy in diabetes mellitus is most often accompanied by high blood sugar levels for many years. Diabetic nephropathy is directly related to high blood pressure, so in diabetics with arterial hypertension, this complication develops much faster.

How to prevent development

The key point in the prevention of diabetic nephropathy is adequate control of blood sugar levels, as well as blood pressure. Patients with diabetes should have annual check-ups, including biochemical blood and urine tests, determination of the level of glycated hemoglobin, and ultrasound of the kidneys.

Research results show that lowering glycated hemoglobin levels, as well as blood cholesterol and triglyceride levels, and controlling blood pressure levels can significantly reduce the risk of developing diabetic nephropathy.

Treatment

The choice of treatment for diabetic nephropathy depends on various factors:

• Age, general condition and previous diseases
• Disease duration
• Tolerance to medications and medical procedures
• The earlier the stage of diabetic nephropathy, the easier and more effective the treatment. In later stages, treatment may not be as effective.

Key points in the treatment of diabetic nephropathy:

Medications include drugs to lower blood sugar levels, antihypertensive drugs to lower high blood pressure, and statins, drugs that lower blood cholesterol levels.

In the late stage of diabetic nephropathy - kidney failure - patients are prescribed a procedure such as hemodialysis. Its essence lies in the fact that the patient is forced to regularly go to a specialized dialysis center, where the patient is connected through a special shunt to a hemodialysis machine (artificial kidney), which cleans the blood plasma from metabolic products within a few hours. Of the other methods of treating late-stage nephropathy in chronic renal failure, kidney transplantation is currently used.

Diabetes is a silent killer, regularly elevated sugar levels have little effect on well-being, so many diabetics do not pay special attention to periodically high numbers on the glucometer. As a result, the health of most patients after 10 years is undermined due to the consequences of high sugars. So, kidney damage and a decrease in their functionality, diabetic nephropathy, is diagnosed in 40% of diabetic patients who take insulin, and in 20% of cases - in those who drink hypoglycemic agents. Currently, this disease is the most common cause of disability in diabetes mellitus.

Reasons for the development of nephropathy

The kidneys filter our blood from toxins around the clock, during the day it is cleared many times. The total volume of fluid entering the kidneys is about 2 thousand liters. This process is possible due to the special structure of the kidneys - they are all permeated with a network of microcapillaries, tubules, and vessels.

First of all, accumulations of capillaries into which blood enters suffer from high sugar. They are called renal glomeruli. Under the influence of glucose, their activity changes, the pressure inside the glomeruli increases. The kidneys begin to work in an accelerated mode, proteins enter the urine, which now do not have time to be filtered. Then the capillaries are destroyed, connective tissue grows in their place, and fibrosis occurs. The glomeruli either completely stop their work, or significantly reduce their productivity. Renal failure occurs, urine output decreases, intoxication of the body increases.

In addition to the increase in pressure and destruction of blood vessels due to hyperglycemia, sugar also affects metabolic processes, causing a number of biochemical disorders. Glycosylated (react with glucose, candied) proteins, including those inside the renal membranes, the activity of enzymes increases, which increase the permeability of the walls of blood vessels, and the formation of free radicals increases. These processes accelerate the development of diabetic nephropathy.

In addition to the main cause of nephropathy - an excessive amount of glucose in the blood, scientists identify other factors that affect the likelihood and rate of development of the disease:

• genetic predisposition. It is believed that diabetic nephropathy appears only in individuals with genetic prerequisites. In some patients, there are no changes in the kidneys even with a long absence of compensation for diabetes mellitus;
• high blood pressure;
• infectious diseases of the urinary tract;
• obesity;
• male;
• smoking.

Symptoms of DN

Diabetic nephropathy develops very slowly, for a long time this disease does not affect the life of a diabetic patient. Symptoms are completely absent. Changes in the glomeruli of the kidneys begin only after a few years of life with diabetes. The first manifestations of nephropathy are associated with mild intoxication: lethargy, nasty taste in the mouth, poor appetite. The daily volume of urine increases, urination becomes more frequent, especially at night. The specific gravity of urine decreases, a blood test shows low hemoglobin, elevated creatinine and urea.

At the first sign, contact a specialist so as not to start the disease!

Symptoms of diabetic nephropathy increase as the stage of the disease increases. Obvious, pronounced clinical manifestations occur only after 15-20 years, when irreversible changes in the kidneys reach a critical level. They are expressed in high pressure, extensive edema, severe intoxication of the body.

Classification of diabetic nephropathy

Diabetic nephropathy refers to diseases of the genitourinary system, ICD-10 code N08.3. It is characterized by renal insufficiency, in which the glomerular filtration rate (GFR) decreases.

GFR underlies the division of diabetic nephropathy into stages of development:

1. With initial hypertrophy, the glomeruli become larger, the volume of filtered blood increases. Sometimes there may be an increase in the size of the kidneys. There are no external manifestations at this stage. Analyzes do not show an increased amount of proteins in the urine. GFR >
2. The appearance of changes in the structures of the glomeruli is observed several years after the onset of diabetes mellitus. At this time, the glomerular membrane thickens, the distance between the capillaries increases. After exercise and a significant increase in sugar, protein in the urine can be determined. GFR falls below 90.
3. The onset of diabetic nephropathy is characterized by severe damage to the vessels of the kidneys, and as a result, a constant increase in the amount of protein in the urine. In patients, pressure begins to rise, at first only after physical labor or exercise. GFR falls sharply, sometimes up to 30 ml/min, indicating the onset of chronic renal failure. Prior to this stage at least 5 years. All this time, changes in the kidneys can be reversed with proper treatment and strict adherence to the diet.
4. Clinically significant DN is diagnosed when changes in the kidneys become irreversible, protein in the urine is detected > 300 mg per day, GFR< 30. Для этой стадии характерно высокое артериальное давление, которое плохо снижается лекарственными средствами, отеки тела и лица, скопление жидкости в полостях тела.
5. Terminal diabetic nephropathy is the last stage of this disease. The glomeruli almost cease to filter urine (GFR< 15), в крови растут уровни холестерина, мочевины, падает гемоглобин. Развиваются массивные отеки, начинается тяжелая интоксикация, которая поражает все органы. Предотвратить смерть больного на этой стадии диабетической нефропатии могут только регулярный диализ или трансплантация почки.

General characteristics of the stages of DN

Diagnosis of nephropathy

The main thing in the diagnosis of diabetic nephropathy is to detect the disease at the stages when the kidney dysfunction is still reversible. Therefore, diabetics who are registered with an endocrinologist are prescribed tests once a year to detect microalbuminuria. With the help of this study, it is possible to detect protein in the urine, when it is not yet determined in the general analysis. The analysis is prescribed annually 5 years after the onset of type 1 diabetes and every 6 months after the diagnosis of type 2 diabetes.

If the protein level is higher than normal (30 mg / day), a Reberg test is performed. With its help, it is assessed whether the renal glomeruli are functioning normally. For the test, the entire volume of urine that the kidneys produced per hour (as an option, the daily volume) is collected, and blood is also taken from a vein. Based on data on the amount of urine, the level of creatinine in the blood and urine, the level of GFR is calculated using a special formula.

To distinguish diabetic nephropathy from chronic pyelonephritis, general urine and blood tests are used. With an infectious kidney disease, an increased number of blood leukocytes and bacteria in the urine is found. Renal tuberculosis is distinguished by the presence of leukocyturia and the absence of bacteria. Glomerulonephritis is differentiated on the basis of an x-ray examination - urography.

The transition to the next stages of diabetic nephropathy is determined on the basis of an increase in albumin, the appearance of protein in the OAM. The further development of the disease affects the level of pressure, significantly changes blood counts.

If changes in the kidneys occur much faster than the average numbers, the protein grows strongly, blood appears in the urine, a kidney biopsy is performed - a sample of kidney tissue is taken with a thin needle, which makes it possible to clarify the nature of the changes in it.

Drugs to lower blood pressure in diabetes

At stage 3, hypoglycemic agents can be replaced with those that will not accumulate in the kidneys. At stage 4, type 1 diabetes usually requires an adjustment in insulin. Due to poor kidney function, it takes longer to be removed from the blood, so less is needed now. At the last stage, the treatment of diabetic nephropathy consists in detoxifying the body, increasing the level of hemoglobin, replacing the functions of non-functioning kidneys through hemodialysis. After stabilization of the state, the question of the possibility of transplantation with a donor organ is being considered.

In diabetic nephropathy, anti-inflammatory drugs (NSAIDs) should be avoided, as they worsen kidney function if taken regularly. These are such common medicines as aspirin, diclofenac, ibuprofen and others. Only a doctor who is informed of the patient's nephropathy can treat with these drugs.

There are some peculiarities in the use of antibiotics. For the treatment of bacterial infections in the kidneys in diabetic nephropathy, highly active agents are used, the treatment is longer, with the obligatory control of creatinine levels.

The need for a diet

Treatment of nephropathy in the initial stages largely depends on the content of nutrients and salt that enter the body with food. The diet for diabetic nephropathy is to limit the intake of animal proteins. Proteins in the diet are calculated depending on the weight of the patient with diabetes - from 0.7 to 1 g per kg of weight. The International Diabetes Federation recommends that the calorie content of proteins should be 10% of the total nutritional value of food. It is also worth reducing the amount of fatty foods in order to lower cholesterol and improve the functioning of blood vessels.

Nutrition for diabetic nephropathy should be six times a day so that carbohydrates and proteins from dietary food enter the body more evenly.

Allowed products:

1. Vegetables are the basis of the diet, they should make up at least half of it.
2. Berries and fruits with low GI are allowed only for breakfast.
3. Of the cereals, buckwheat, barley, yachka, brown rice are preferred. They are put in the first courses and used as part of side dishes along with vegetables.
4. Milk and dairy products. Butter, sour cream, sweet yoghurts and curds are contraindicated.
5. One egg per day.
6. Legumes as garnishes and in soups in limited quantities. Plant protein is safer for dietary nephropathy than animal protein.
7. Lean meat and fish, preferably 1 time per day.

Starting from stage 4, and if there is hypertension, then even earlier, salt restriction is recommended. They stop adding salt to food, exclude salted and pickled vegetables, mineral water. Clinical studies have shown that reducing salt intake to 2 g per day (half a teaspoon) reduces pressure and swelling. To achieve such a reduction, you need not only to remove salt from your kitchen, but also to stop buying ready-made convenience foods and bread products.

• High sugar is the main cause of the destruction of the vessels of the body, so it is important to know -.
• - if they are all studied and eliminated, then the appearance of various complications can be postponed for a long time.

Among all the complications that diabetes threatens a person, diabetic nephropathy occupies a leading position. The first changes in the kidneys appear already in the first years after diabetes, and the final stage is chronic renal failure (CRF). But the most careful observance of preventive measures, timely diagnosis and adequate treatment help to delay the development of this disease as much as possible.

diabetic nephropathy

Diabetic nephropathy is not one independent disease. This term combines a whole series of different problems, the essence of which boils down to one thing - this is damage to the renal vessels against the background of chronic diabetes mellitus.

In the group of diabetic nephropathy most often reveal:

• arteriosclerosis of the renal artery;
• diabetic glomerulosclerosis;
• fatty deposits in the renal tubules;
• pyelonephritis;
• necrosis of the renal tubules, etc.

Nephropathy due to diabetes mellitus is often called Kimmelstiel-Wilson syndrome (according to one of the forms of glomerulosclerosis). In addition, the concepts of diabetic glomerulosclerosis and nephropathy are often used in medical practice as synonymous.

The ICD-10 code (the official International Classification of Diseases of the 10th revision), which has been in effect everywhere since 1909, uses 2 codes for this syndrome. And in various medical sources, patient charts and reference books, you can find both options. These are E.10-14.2 (Diabetes mellitus with kidney damage) and N08.3 (Glomerular lesions in diabetes mellitus).

Most often, various disorders of kidney function are recorded in type 1 diabetes, that is, insulin-dependent. Nephropathy occurs in 40-50% of diabetic patients and is recognized as the leading cause of death from complications in this group. In people suffering from type 2 pathology (insulin independent), nephropathy is recorded only in 15-30% of cases.

Kidneys in diabetes

Reasons for the development of the disease

Violation of the full functioning of the kidneys is one of the earliest consequences of diabetes mellitus. After all, it is the kidneys that have the main job of cleansing the blood from excess impurities and toxins.

When the level of glucose in the blood of a diabetic jumps sharply, it acts on the internal organs as a dangerous toxin. It is becoming increasingly difficult for the kidneys to cope with their filtration task. As a result, blood flow weakens, sodium ions accumulate in it, which provoke narrowing of the lumen of the renal vessels. The pressure in them rises (hypertension), the kidneys begin to collapse, which causes an even greater increase in pressure.

But, despite this vicious circle, kidney damage does not develop in all patients with diabetes.

Therefore, doctors identify 3 main theories that name the causes of the development of renal ailments.

1. Genetic. One of the primary reasons why a person develops diabetes mellitus is today called hereditary predisposition. The same mechanism is attributed to nephropathy. Once a person develops diabetes, mysterious genetic mechanisms accelerate the development of vascular damage in the kidneys.
2. Hemodynamic. In diabetes, there is always a violation of the renal circulation (the same hypertension). As a result, a large amount of albumin proteins is found in the urine, the vessels under such pressure are destroyed, and the damaged areas are covered with scar tissue (sclerosis).
3. Exchange. This theory assigns the main destructive role to elevated blood glucose. All blood vessels in the body (including the kidneys) suffer from exposure to the "sweet" toxin. The vascular blood flow is disturbed, normal metabolic processes change, fats are deposited in the vessels, which leads to nephropathy.

Classification

Today, doctors in their work use the generally accepted classification according to the stages of diabetic nephropathy according to Mogensen (developed in 1983):

But often in the reference literature there is also a division of diabetic nephropathy into stages based on changes in the kidneys. Here are the stages of the disease:

1. Hyperfiltration. At this time, the blood flow in the renal glomeruli accelerates (they are the main filter), the volume of urine increases, the organs themselves slightly increase in size. The stage lasts up to 5 years.
2. Microalbuminuria. This is a slight increase in the level of albumin proteins in the urine (30-300 mg / day), which conventional laboratory methods are not yet able to detect. If these changes are diagnosed in time and treated in time, the stage can last about 10 years.
3. Proteinuria (in other words - macroalbuminuria). Here, the rate of blood filtration through the kidneys decreases sharply, and renal arterial pressure (BP) often jumps. Urinary albumin levels at this stage can range from 200 to over 2000 mg/day. This phase is diagnosed on the 10-15th year from the onset of the disease.
4. Severe nephropathy. GFR decreases even more, the vessels are covered with sclerotic changes. It is diagnosed 15-20 years after the first changes in the renal tissue.
5. Chronic renal failure. Appears after 20-25 years of life with diabetes.

Scheme of the development of diabetic nephropathy

Symptoms

The first three stages of renal pathology according to Mogensen (or periods of hyperfiltration and microalbuminuria) are called preclinical. At this time, external symptoms are completely absent, the volume of urine is normal. Only in some cases, patients may notice a periodic increase in pressure at the end of the microalbuminuria stage.

At this time, only special tests for the quantitative determination of albumin in the urine of a diabetic patient can diagnose the disease.

The stage of proteinuria already has specific external signs:

• regular jumps in blood pressure;
• patients complain of edema (first, the face and legs swell, then water accumulates in the body cavities);
• weight drops sharply and appetite decreases (the body begins to spend protein reserves to make up for the shortage);
• severe weakness, drowsiness;
• thirst and nausea.

At the final stage of the disease, all of the above symptoms persist and intensify. Edema is getting stronger, droplets of blood are visible in the urine. Arterial pressure in the renal vessels rises to life-threatening numbers for the patient.

Diagnostics

Diagnosis of diabetic kidney damage occurs on the basis of two main indicators. These are data on the anamnesis of a diabetic patient (type of diabetes mellitus, how long the disease lasts, etc.) and indicators of laboratory research methods.

At the preclinical stage of development of vascular lesions of the kidneys, the main method is the quantitative determination of albumin in the urine. For analysis, either the total volume of urine per day, or the morning (that is, the night portion) is taken.

Albumin indicators are classified as follows:

Another important diagnostic method is the detection of functional renal reserve (increase in GFR in response to external stimulation, for example, dopamine administration, protein load, etc.). A 10% increase in GFR after the procedure is considered normal.

The norm of the GFR indicator itself is ≥90 ml / min / 1.73 m2. If this figure falls below, this indicates a decrease in kidney function.

Additional diagnostic procedures are also used:

• Reberg's test (determination of GFR);
• general analysis of blood and urine;
• Ultrasound of the kidneys with Doppler (to determine the speed of blood flow in the vessels);
• kidney biopsy (according to individual indications).

Treatment

In the early stages, the main task in the treatment of diabetic nephropathy is to maintain adequate glucose levels and treat arterial hypertension. When the stage of proteinuria develops, all therapeutic measures should be addressed in order to slow down the decline in kidney function and the appearance of CRF.

Preparations

The following medicines are used:

• ACE inhibitors - angiotensin-converting enzyme, for pressure correction (Enalapril, Captopril, Fosinopril, etc.);
• drugs for the correction of hyperlipidemia, that is, an increased level of fats in the blood ("Simvastatin" and other statins);
• diuretics ("Indapamide", "Furosemide");
• iron preparations for the correction of anemia, etc.

Diet

A special low-protein diet is recommended already in the preclinical phase of diabetic nephropathy - with hyperfiltration of the kidneys and microalbuminuria. During this period, you need to reduce the "portion" of animal proteins in the daily diet to 15-18% of the total calorie content. This is 1 g per 1 kg of body weight of a diabetic patient. The daily amount of salt also needs to be sharply reduced - up to 3-5 g. It is important to limit fluid intake in order to reduce swelling.

If the stage of proteinuria has developed, special nutrition becomes a full-fledged therapeutic method. The diet turns into a low-protein diet - 0.7 g of protein per 1 kg. The volume of salt consumed should be reduced as much as possible, to 2-2.5 g per day. This will prevent severe swelling and reduce pressure.

In some cases, patients with diabetic nephropathy are prescribed ketone analogs of amino acids to prevent the body from breaking down proteins from its own reserves.

Hemodialysis and peritoneal dialysis

Artificial blood purification by hemodialysis (“artificial kidney”) and dialysis is usually carried out in the later stages of nephropathy, when native kidneys can no longer cope with filtration. Sometimes hemodialysis is also prescribed at earlier stages, when diabetic nephropathy has already been diagnosed, and organs need to be supported.

During hemodialysis, a catheter is inserted into the patient's vein, connected to a hemodialyzer - a filtering device. And the whole system cleanses the blood of toxins instead of the kidney within 4-5 hours.

The procedure for peritoneal dialysis follows a similar pattern, but the cleansing catheter is not inserted into the artery, but into the peritoneum. This method is used when hemodialysis is not possible for various reasons.

How often blood purifying procedures are needed, only the doctor decides based on the tests and the condition of the diabetic patient. If nephropathy has not yet turned into CRF, you can connect an "artificial kidney" once a week. When kidney function is already running out, hemodialysis is done three times a week. Peritoneal dialysis can be done daily.

Artificial blood purification in nephropathy is necessary when the GFR falls to 15 ml / min / 1.73 m2 and an abnormally high level of potassium is recorded below (more than 6.5 mmol / l). And also if there is a risk of pulmonary edema due to accumulated water, and also there are all signs of protein-energy deficiency.

Prevention

For diabetic patients, the prevention of nephropathy should include several main points:

• support in the blood of a safe level of sugar (regulate physical activity, avoid stress and constantly measure glucose levels);
• proper nutrition (diet with a reduced percentage of proteins and carbohydrates, avoiding cigarettes and alcohol);
• control over the ratio of lipids in the blood;
• monitoring the level of blood pressure (if it jumps above 140/90 mm Hg, urgent action must be taken).

All preventive measures must be agreed with the attending physician. A therapeutic diet should also be carried out under the strict supervision of an endocrinologist and a nephrologist.

Diabetic Nephropathy and Diabetes

The treatment of diabetic nephropathy cannot be separated from the treatment of the cause - the diabetes itself. These two processes should run in parallel and be adjusted according to the diabetic patient's test results and the stage of the disease.

The main tasks in both diabetes and kidney damage are the same - round-the-clock control of glucose levels and blood pressure. The main non-drug remedies are the same for all stages of diabetes. This is weight control, healthy nutrition, reducing the amount of stress, giving up bad habits, and regular physical activity.

The situation with medication is somewhat more complicated. In the early stages of diabetes and nephropathy, the main group of drugs is for the correction of pressure. Here it is necessary to choose medicines that are safe for patients with kidney disease, are allowed for other complications of diabetes, and have both cardioprotective and nephroprotective properties. These are the majority of ACE inhibitors.

In insulin-dependent diabetes, ACE inhibitors are allowed to be replaced by angiotensin II receptor antagonists if there are side effects from the first group of drugs.

When tests already show proteinuria, reduced kidney function and severe hypertension must be considered in the management of diabetes. Particular restrictions apply to diabetics with type 2 pathology: for them, the list of approved oral hypoglycemic agents (OSSS) that must be taken constantly is sharply reduced. The safest drugs are Gliquidone, Gliklazide, Repaglinide. If GFR falls to 30 ml/min or below in nephropathy, patients need to be switched to insulin.

There are also special drug regimens for diabetics, depending on the stage of nephropathy, albumin, creatinine and GFR. So, if creatinindo rises to 300 µmol / l, the dosage of the ATP inhibitor is halved, if it jumps higher, and is completely canceled - before hemodialysis is performed. In addition, modern medicine is constantly searching for new drugs and therapeutic regimens that allow simultaneous treatment of diabetes and diabetic nephropathy with minimal complications.
On the video about the causes, symptoms and treatment of diabetic nephropathy:

Diabetic Nephropathy: Find out everything you need to know. Below are detailed descriptions of its symptoms and diagnosis using blood and urine tests, as well as ultrasound of the kidneys. Most importantly, it is told about effective methods of treatment that allow keep blood sugar 3.9-5.5 mmol/l stable 24 hours a day like in healthy people. The type 2 and type 1 diabetes control system helps the kidneys heal if the nephropathy hasn't gone too far. Find out what microalbuminuria, proteinuria are, what to do if the kidneys hurt, how to normalize blood pressure and creatinine in the blood.

Diabetic nephropathy is kidney damage caused by high blood glucose levels. Smoking and hypertension also damage the kidneys. Within 15-25 years in a diabetic, both of these organs can fail, and dialysis or transplantation will be needed. This page details folk remedies and official treatments to avoid kidney failure, or at least slow down its development. Recommendations are given, the implementation of which not only protects the kidneys, but also reduces the risk of heart attack and stroke.

Learn how diabetes affects the kidneys, the symptoms, and the diagnostic algorithm for diabetic nephropathy. Figure out what tests you need to pass, how to decipher their results, how useful ultrasound of the kidneys is. Read about treatment through diet, medications, home remedies, and transition to a healthy lifestyle. The nuances of kidney treatment in patients with type 2 diabetes are described. It is described in detail about pills that reduce blood sugar and blood pressure. In addition to them, you may need statins for cholesterol, aspirin, anemia drugs.

Read the answers to the questions:

Theory: the bare minimum

The kidneys are responsible for filtering waste products from the blood and excreting them in the urine. They also produce the hormone erythropoietin, which stimulates the production of red blood cells - erythrocytes.

Blood periodically passes through the kidneys, which remove waste from it. Purified blood circulates further. Poisons and metabolic products, as well as excess salt, dissolved in a large amount of water, form urine. It drains into the bladder, where it is temporarily stored.

Each kidney contains about a million filter elements called nephrons. A glomerulus of small blood vessels (capillaries) is one of the components of the nephron. Glomerular filtration rate is an important indicator that determines the state of the kidneys. It is calculated based on the content of creatinine in the blood.

Creatinine is one of the breakdown products that the kidneys excrete. In kidney failure, it accumulates in the blood along with other waste products, and the patient feels the symptoms of intoxication. Kidney problems can be caused by diabetes, infection, or other causes. In each of these cases, the glomerular filtration rate is measured to assess the severity of the disease.

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How does diabetes affect the kidneys?

Elevated blood sugar damages the filter elements of the kidneys. Over time, these disappear and are replaced by scar tissue that cannot clear waste from the blood. The fewer filter elements left, the worse the kidneys work. In the end, they cease to cope with the excretion of waste and intoxication of the body occurs. At this stage, the patient needs replacement therapy in order not to die - dialysis or a kidney transplant.

Before they die completely, the filter elements become “leaky”, they begin to “leak”. They pass proteins into the urine that should not be there. Namely, albumin in high concentration.

Microalbuminuria is the excretion of albumin in the urine in the amount of 30-300 mg per day. Proteinuria - albumin is found in the urine in an amount of more than 300 mg per day. Microalbuminuria may stop if treatment is successful. Proteinuria is a more serious problem. It is considered irreversible and signals that the patient has embarked on the path of developing renal failure.

The worse the control of diabetes, the higher the risk of end-stage renal disease and the sooner it can occur. The chances of experiencing complete kidney failure in diabetics are actually not very high. Because most of them die from a heart attack or stroke before the need for renal replacement therapy arises. However, the risk is increased for patients who have diabetes associated with smoking or a chronic urinary tract infection.

In addition to diabetic nephropathy, there may also be renal artery stenosis. This is a blockage of atherosclerotic plaques in one or both of the arteries that feed the kidneys. At the same time, blood pressure rises greatly. Hypertension medications do not help, even if you take several types of powerful pills at the same time.

Renal artery stenosis often requires surgical treatment. Diabetes increases the risk of this disease because it stimulates the development of atherosclerosis, including in the vessels that feed the kidneys.

Kidneys in type 2 diabetes

Type 2 diabetes usually goes unnoticed for several years before it is discovered and treated. All these years, complications gradually destroy the patient's body. They do not bypass the kidneys.

According to English-language websites, by the time of diagnosis, 12% of patients with type 2 diabetes already have microalbuminuria, and 2% have proteinuria. Among Russian-speaking patients, these figures are several times higher. Because Westerners have a habit of regularly undergoing preventive medical examinations. Due to this, chronic diseases are detected in them more timely.

Type 2 diabetes may coexist with other risk factors for chronic kidney disease:

• high blood pressure;
• elevated blood cholesterol levels;
• there were cases of kidney disease in close relatives;
• in the family there were cases of early heart attack or stroke;
• smoking;
• obesity;
• elderly age.

What is the difference between kidney complications in type 2 and type 1 diabetes?

In type 1 diabetes, kidney complications usually develop 5 to 15 years after the onset of the disease. In type 2 diabetes, these complications are often detected immediately at diagnosis. Because type 2 diabetes is usually latent for many years before the patient notices the symptoms and guesses to check their blood sugar. Until a diagnosis is made and treatment is not started, the disease freely destroys the kidneys and the entire body.

Type 2 diabetes is less severe than type 1 diabetes. However, it occurs 10 times more often. Patients with type 2 diabetes are the largest group of patients served by dialysis centers and kidney transplant specialists. The type 2 diabetes epidemic is on the rise worldwide and in Russian-speaking countries. This adds work to specialists who treat complications in the kidneys.

In type 1 diabetes, nephropathy most often occurs in patients whose disease began in childhood and adolescence. For people who develop type 1 diabetes in adulthood, the risk of kidney problems is not very high.

Symptoms and Diagnosis

In the first months and years, diabetic nephropathy and microalbuminuria do not cause any symptoms. Patients notice problems only when end-stage renal disease is within easy reach. In the beginning, the symptoms are vague, reminiscent of a cold or chronic fatigue.

Early signs of diabetic nephropathy:

Why is blood sugar low in diabetic nephropathy?

Indeed, with diabetic nephropathy in the last stage of renal failure, blood sugar levels may decrease. In other words, the need for insulin decreases. It is necessary to reduce its doses so that there is no hypoglycemia.

Why is this happening? Insulin is destroyed in the liver and kidneys. When the kidneys are severely damaged, they lose their ability to excrete insulin. This hormone stays in the blood longer and stimulates cells to absorb glucose.

End-stage renal failure is a disaster for diabetics. The ability to reduce the dose of insulin is only small consolation.

What tests need to be done? How to decipher the results?

To make an accurate diagnosis and select an effective treatment, you need to pass tests:

• protein (albumin) in the urine;
• the ratio of albumin and creatinine in the urine;
• creatinine in the blood.

Creatinine is one of the breakdown products of protein, which is excreted by the kidneys. Knowing the level of creatinine in the blood, as well as the age and gender of a person, it is possible to calculate the glomerular filtration rate. This is an important indicator on the basis of which the stage of diabetic nephropathy is determined and treatment is prescribed. The doctor may also order other tests.

Interpretation of test results

In preparation for the blood and urine tests listed above, you need to refrain from serious physical exertion and drinking alcohol for 2-3 days. Otherwise, the results will be worse than in reality.

On the creatinine blood test result form, the normal range for your gender and age should be indicated, and the glomerular filtration rate of the kidneys should be calculated. The higher this figure, the better.

What is microalbuminuria?

Microalbuminuria is the appearance of protein (albumin) in the urine in small amounts. It is an early symptom of diabetic kidney disease. Considered a risk factor for heart attack and stroke. Microalbuminuria is considered reversible. Medication, proper control of glucose levels and blood pressure can reduce the amount of albumin in the urine to normal for several years.

What is proteinuria?

Proteinuria is the presence of protein in the urine in large quantities. Quite a bad sign. It means that a heart attack, stroke or terminal renal failure is just around the corner. Requires urgent intensive treatment. Moreover, it may turn out that the time for effective treatment has already been lost.

If you find microalbuminuria or proteinuria, you need to consult a doctor who treats the kidneys. This specialist is called a nephrologist, not to be confused with a neurologist. Make sure that the cause of the protein in the urine is not an infectious disease or injury to the kidneys.

It may turn out that overloads are the cause of the poor analysis result. In this case, re-analysis after a few days will give a normal result.

How does the level of cholesterol in the blood affect the development of complications of diabetes in the kidneys?

Officially, it is believed that elevated blood cholesterol stimulates the development of atherosclerotic plaques. Atherosclerosis simultaneously affects many vessels, including those that carry blood to the kidneys. It is implied that diabetics need to take statins for cholesterol, and this will delay the development of kidney failure.

However, the hypothesis of a protective effect of statins on the kidneys is controversial. And the serious side effects of these drugs are well known. It makes sense to take statins to avoid a second heart attack if you already had the first one. Of course, reliable prevention of a second heart attack should include many other measures besides taking cholesterol pills. It is hardly worth taking statins if you have not yet had a heart attack.

How often do diabetics need a kidney ultrasound?

Ultrasound of the kidneys makes it possible to check whether there are sand and stones in these organs. Also, with the help of an examination, benign kidney tumors (cysts) can be detected.

However, ultrasound is almost useless for diagnosing diabetic nephropathy and monitoring the effectiveness of its treatment. It is much more important to regularly take blood and urine tests, which are detailed above.

What are the signs of diabetic nephropathy on ultrasound?

The fact of the matter is that diabetic nephropathy gives almost no signs on ultrasound of the kidneys. The patient's kidneys may appear to be in good condition, even if their filter elements are already damaged and not working. The real picture will give you the results of blood and urine tests.

Diabetic nephropathy: classification

Diabetic nephropathy is divided into 5 stages. The last one is called terminal. At this stage, the patient needs replacement therapy to avoid death. It comes in two forms: dialysis several times a week or a kidney transplant.

Stages of Chronic Kidney Disease

There are usually no symptoms in the first two stages. Diabetic kidney disease can only be detected by blood and urine tests. Note that renal ultrasound is not of much benefit.

When the disease progresses to the third and fourth stages, visible signs may appear. However, the disease develops smoothly, gradually. Because of this, patients often get used to it and do not sound the alarm. Obvious symptoms of intoxication appear only in the fourth and fifth stages, when the kidneys almost do not work.

Diagnosis options:

• DN, MAU stage, CKD 1, 2, 3, or 4;
• DN, stage of proteinuria with preserved kidney function to excrete nitrogen, CKD 2, 3 or 4;
• DN, stage PN, CKD 5, RRT treatment.

DN - diabetic nephropathy, MAU - microalbuminuria, PN - renal failure, CKD - ​​chronic kidney disease, RRT - renal replacement therapy.

Proteinuria usually begins in patients with type 2 and type 1 diabetes who have had the disease for 15–20 years. If left untreated, end-stage renal disease can occur in another 5-7 years.

What to do if the kidneys hurt with diabetes?

First of all, you should make sure that it is the kidneys that hurt. Perhaps you do not have a problem with the kidneys, but osteochondrosis, rheumatism, pancreatitis, or some other ailment that causes a similar pain syndrome. You need to see a doctor to determine the exact cause of the pain. This cannot be done on your own.

Self-medication can seriously harm. Complications of diabetes on the kidneys usually do not cause pain, but the symptoms of intoxication listed above. Kidney stones, renal colic and inflammation, most likely, are not directly related to impaired glucose metabolism.

Treatment

Treatment of diabetic nephropathy aims to prevent or at least delay the onset of end-stage renal disease, which will require dialysis or a donor organ transplant. It is to maintain good blood sugar and blood pressure.

It is necessary to monitor the level of creatinine in the blood and protein (albumin) in the urine. Also, official medicine recommends monitoring blood cholesterol and trying to lower it. But many experts doubt that this is really useful. Remedial actions to protect the kidneys reduce the risk of heart attack and stroke.

What should a diabetic take to save the kidneys?

Of course, it is important to take pills to prevent complications in the kidneys. Diabetics are usually prescribed several groups of drugs:

1. Pressure pills - primarily ACE inhibitors and angiotensin-II receptor blockers.
2. Aspirin and other antiplatelet agents.
3. Statins for cholesterol.
4. Remedies for anemia that can be caused by kidney failure.

All of these drugs are described in detail below. However, nutrition plays a major role. Taking medication has many times less impact than the diet followed by a diabetic. The main thing you need to do is decide on the transition to a low-carb diet. Read more below.

Do not count on folk remedies if you want to protect yourself from diabetic nephropathy. Herbal teas, infusions and decoctions are useful only as a source of fluid, for the prevention and treatment of dehydration. They do not have a serious protective effect on the kidneys.

How to treat kidneys in diabetes?

First of all, diet and insulin injections are used to keep blood sugar as close to normal as possible. Maintaining below 7% reduces the risk of proteinuria and kidney failure by 30-40%.

The use of methods allows you to keep sugar stably normal, as in healthy people, and glycated hemoglobin below 5.5%. It is likely that such indicators reduce the risk of severe kidney complications to zero, although this has not been confirmed by official studies.

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There is evidence that with a stable normal level of glucose in the blood, the kidneys affected by diabetes are healed and restored. However, this is a slow process. In stages 4 and 5 of diabetic nephropathy, it is generally impossible.

Officially recommended food with limited protein and animal fats. The appropriateness of use is discussed below. With normal values ​​of blood pressure, it is necessary to limit salt intake to 5-6 g per day, and with elevated values ​​- up to 3 g per day. Actually, it's not very small.

Healthy lifestyle to protect the kidneys:

1. Quit smoking.
2. Study the article "" and drink no more than indicated there.
3. If you don't drink alcohol, don't even start.
4. Try to lose weight and definitely not gain more excess weight.
5. Discuss with your doctor what kind of physical activity is right for you and exercise.
6. Have a blood pressure monitor at home and regularly measure your blood pressure with it.

There are no magic pills, tinctures, and even more so, folk remedies that could quickly and easily restore kidneys affected by diabetes.

Tea with milk does not help, but rather harms, because milk increases blood sugar. Hibiscus is a popular tea drink that helps no more than drinking pure water. Better not even try folk remedies, hoping to cure the kidneys. Self-treatment of these filtering organs is extremely dangerous.

What medications are prescribed?

Patients diagnosed with diabetic nephropathy at one stage or another usually use several drugs at the same time:

• tablets for hypertension - 2-4 types;
• statins for cholesterol;
• antiplatelet agents - aspirin and dipyridamole;
• drugs that bind excess phosphorus in the body;
• maybe even a remedy for anemia.

Taking multiple pills is the easiest thing to do to avoid or delay the onset of end-stage renal disease. Study or. Follow the instructions carefully. The transition to a healthy lifestyle requires more serious efforts. However, it needs to be implemented. You can't get away with medication if you want to protect your kidneys and live longer.

Which blood sugar lowering pills are suitable for diabetic nephropathy?

Unfortunately, the most popular drug metformin (Siofor, Glucofage) should be excluded already in the early stages of diabetic nephropathy. It cannot be taken if the glomerular filtration rate of the kidneys in a patient is 60 ml / min, and even more so, lower. This corresponds to the levels of creatinine in the blood:

• for men - above 133 µmol/l
• for women - above 124 µmol/l

Recall that the higher the creatinine, the worse the kidneys work and the lower the glomerular filtration rate. Already at an early stage of complications of diabetes on the kidneys, it is necessary to exclude metformin from the treatment regimen in order to avoid dangerous lactic acidosis.

Officially, patients with diabetic retinopathy are allowed to take medications that cause the pancreas to produce more insulin. For example, Diabeton MV, Amaryl, Maninil and their analogues. However, these drugs are included in. They deplete the pancreas and do not reduce the mortality of patients, and even increase it. Better not to use them. Diabetics who develop kidney complications should replace sugar-lowering pills with insulin injections.

Some diabetes medications can be taken, but carefully, in consultation with your doctor. As a rule, they cannot provide good enough control of glucose levels and do not provide an opportunity to refuse insulin injections.

What blood pressure pills should I take?

Very important pills for hypertension, which belong to the groups of ACE inhibitors or angiotensin-II receptor blockers. They not only lower blood pressure, but also provide additional protection to the kidneys. Taking these drugs helps to delay the onset of end-stage renal disease for several years.

You should try to keep your blood pressure below 130/80 mm Hg. Art. To do this, you usually have to use several types of drugs. Start with ACE inhibitors or angiotensin II receptor blockers. They are also supplemented with drugs from other groups - beta-blockers, diuretics (diuretics), calcium channel blockers. Ask your doctor to prescribe you a convenient combination tablet that contains 2-3 active ingredients under one shell to be taken once a day.

ACE inhibitors or angiotensin-II receptor blockers at the beginning of treatment may increase the level of creatinine in the blood. Discuss with your doctor how serious this is. Most likely, it is not necessary to cancel the medication. Also, these drugs can increase the level of potassium in the blood, especially if combined with each other or with diuretic drugs.

A very high concentration of potassium can cause cardiac arrest. To avoid it, you should not combine ACE inhibitors and angiotensin-II receptor blockers, as well as drugs called potassium-sparing diuretics. Blood tests for creatinine and potassium, as well as urine for protein (albumin) should be taken once a month. Don't be lazy to do it.

Do not use on your own initiative statins for cholesterol, aspirin and other antiplatelet agents, drugs and dietary supplements for anemia. All of these pills can cause serious side effects. Talk to your doctor about the need to take them. Also, the doctor should be engaged in the selection of drugs for hypertension.

The patient's task is not to be lazy to take regular tests and, if necessary, consult a doctor to correct the treatment regimen. Your primary means of achieving good blood glucose levels is insulin, not diabetes pills.

How to be treated if you have been diagnosed with Diabetic Nephropathy and there is a lot of protein in the urine?

Your doctor will prescribe you several types of medications, which are described on this page. All prescribed tablets must be taken daily. This can delay a cardiovascular event, the need for dialysis, or a kidney transplant by several years.

Good diabetes control rests on three pillars:

1. Compliance.
2. Frequent measurement of blood sugar.
3. Injections of carefully selected doses of prolonged and rapid insulin.

These measures make it possible to maintain a stable normal glucose level, as in healthy people. In this case, the development of diabetic nephropathy stops. Moreover, against the background of stable normal blood sugar, diseased kidneys can restore their function over time. This means that the glomerular filtration rate will go up, and protein will disappear from the urine.

However, achieving and maintaining good diabetes control is not an easy task. To cope with it, the patient must have high discipline and motivation. You can be inspired by the personal example of Dr. Bernstein, who completely eliminated the protein in the urine and restored normal kidney function.

Without switching to a low-carb diet, it is generally impossible to bring sugar back to normal in diabetes. Unfortunately, a low-carbohydrate diet is contraindicated for diabetics who have a low glomerular filtration rate, and even more so, have developed end-stage renal disease. In this case, you should try to carry out a kidney transplant. Read more about this operation below.

What should a patient with diabetic nephropathy and high blood pressure do?

Switching to improves not only blood sugar, but also cholesterol and blood pressure. In turn, the normalization of glucose levels and blood pressure inhibits the development of diabetic nephropathy.

However, if kidney failure has developed to an advanced stage, it is too late to switch to a low-carbohydrate diet. It remains only to take the pills prescribed by the doctor. Kidney transplantation can give a real chance for salvation. This is detailed below.

Of all the drugs for hypertension, ACE inhibitors and angiotensin-II receptor blockers provide the best protection for the kidneys. You should take only one of these drugs, they can not be combined with each other. However, it can be combined with taking beta-blockers, diuretic drugs, or calcium channel blockers. Usually, convenient combined tablets are prescribed, which contain 2-3 active ingredients under one shell.

What are good folk remedies for the treatment of kidneys?

Relying on herbs and other folk remedies for kidney problems is the worst thing you can do. Traditional medicine does not help at all with diabetic nephropathy. Stay away from charlatans who tell you otherwise.

Fans of folk remedies quickly die from complications of diabetes. Some of them die relatively easily from a heart attack or stroke. Others suffer from kidney problems, rotting legs, or blindness before they die.

Among the folk remedies for diabetic nephropathy are lingonberries, strawberries, chamomile, cranberries, rowan fruits, wild rose, plantain, birch buds and dry bean leaves. From the listed herbal remedies, teas and decoctions are prepared. Again, they have no real protective effect on the kidneys.

Take an interest in dietary supplements for hypertension. This is, first of all, magnesium with vitamin B6, as well as taurine, coenzyme Q10 and arginine. They provide some benefit. They can be taken in addition to medications, but not instead of them. In severe diabetic nephropathy, these supplements may be contraindicated. Check with your doctor about this.

How to reduce blood creatinine in diabetes?

Creatinine is one of the waste products that the kidneys remove from the body. The closer to normal the creatinine in the blood, the better the kidneys work. The diseased kidneys cannot cope with the excretion of creatinine, which is why it accumulates in the blood. According to the results of the analysis for creatinine, the glomerular filtration rate is calculated.

To protect the kidneys, diabetics are often given pills called ACE inhibitors or angiotensin-II receptor blockers. The level of creatinine in the blood may rise for the first time after starting these medicines. However, later it is likely to decrease. If you have elevated creatinine levels, talk to your doctor about how serious it is.

Is it possible to restore the normal glomerular filtration rate of the kidneys?

Officially, it is believed that the glomerular filtration rate cannot increase after it has decreased significantly. However, most likely, kidney function in diabetics can be restored. To do this, you need to maintain stable normal blood sugar, as in healthy people.

You can reach the specified goal using or . However, this is not easy, especially if complications of diabetes on the kidneys have already developed. The patient needs to have high motivation and discipline for daily adherence to the regimen.

Please note that if the development of diabetic nephropathy has passed the point of no return, then it is too late to move on. The point of no return is the glomerular filtration rate of 40-45 ml/min.

Diabetic Nephropathy: Diet

The official recommendation is to keep it below 7% using a protein- and animal-fat-restricted diet. First of all, they try to replace red meat with chicken, and even better - with vegetable sources of protein. supplement with insulin injections and medication. This must be done carefully. The more impaired renal function, the lower the required doses of insulin and tablets, the higher the risk of overdose.

Many doctors believe that it harms the kidneys, accelerates the development of diabetic nephropathy. This is a tricky issue and needs to be carefully considered. Because the choice of diet is the most important decision that a diabetic and his relatives need to make. Everything depends on nutrition in diabetes. Medications and insulin play a much smaller role.

In July 2012, the clinical journal of the American Society of Nephrology published a comparison of the effect on the kidneys of a low-carb and low-fat diet. The results of the study, which included 307 patients, proved that a low-carbohydrate diet is not harmful. The test was carried out from 2003 to 2007. It was attended by 307 obese people who wanted to lose weight. Half of them were put on a low-carbohydrate diet, and the other half were put on a low-calorie, fat-restricted diet.

Participants were followed up for an average of 2 years. Serum creatinine, urea, daily urine volume, excretion of albumin, calcium and electrolytes in the urine were regularly measured. The low-carbohydrate diet increased the daily volume of urine. But there was no evidence of decreased glomerular filtration rate, kidney stone formation, or bone softening due to calcium deficiency.

Read about products for diabetics:

There was no difference in weight loss between participants in both groups. However, for diabetics, a low-carbohydrate diet is the only option to keep blood sugar stable and avoid spikes. This diet helps control impaired glucose metabolism, regardless of its effect on body weight.

At the same time, a diet with limited fat, overloaded with carbohydrates, is undoubtedly harmful for diabetics. The study described above involved people who did not have diabetes. It does not provide an answer to the question of whether a low-carbohydrate diet accelerates the development of diabetic nephropathy, if it has already begun.

Information from Dr. Bernstein

All that is stated below is personal practice, not supported by serious research. In people with healthy kidneys, the glomerular filtration rate is 60-120 ml / min. High blood glucose levels gradually destroy the filter elements. Because of this, the glomerular filtration rate decreases. When it falls to 15 ml/min and below, the patient needs dialysis or kidney transplantation to avoid death.

Dr. Bernstein believes that it can be prescribed if the glomerular filtration rate is above 40 ml / min. The goal is to reduce sugar to normal and keep it consistently normal 3.9-5.5 mmol / l, as in healthy people.

To achieve this goal, you need to not only follow a diet, but use the whole or. The package of measures includes a low-carbohydrate diet, as well as low-dose insulin injections, taking pills, and physical activity.

In patients who have achieved normal blood glucose levels, the kidneys begin to recover and diabetic nephropathy may disappear completely. However, this is possible only if the development of complications has not gone too far. The glomerular filtration rate of 40 ml/min is the threshold value. If it is achieved, the patient can only follow a protein-restricted diet. Because a low-carbohydrate diet can accelerate the development of end-stage renal disease.

Diet options depending on the diagnosis:

Again, you may use this information at your own risk. It is possible that a low-carbohydrate diet harms the kidneys even at higher glomerular filtration rates than 40 ml/min. There have been no formal studies of its safety in diabetics.

Do not limit yourself to dieting, but use the whole range of measures to keep your blood glucose levels stable and normal. In particular, understand . Blood and urine tests to check kidney function should not be done after heavy exercise or heavy drinking. Wait 2-3 days, otherwise the results will be worse than they really are.

How long do diabetics live with chronic renal failure?

Consider two situations:

1. The glomerular filtration rate of the kidneys is not yet greatly reduced.
2. The kidneys no longer work, the patient is treated with dialysis.

In the first case, you can try to keep your blood sugar stable and normal, as in healthy people. Read more or. Careful implementation of the recommendations will make it possible to slow down the development of diabetic nephropathy and other complications, and even restore the ideal functioning of the kidneys.

The life expectancy of a diabetic can be the same as that of healthy people. It depends very much on the motivation of the patient. Daily adherence to healing recommendations requires outstanding discipline. However, there is nothing impossible in this. Diabetes control activities take 10-15 minutes a day.

The life expectancy of diabetics who are treated with dialysis depends on whether they have the prospect of waiting for a kidney transplant. The existence of dialysis patients is very painful. Because they have consistently poor health and weakness. Also, a rigid schedule of cleansing procedures deprives them of the opportunity to lead a normal life.

Official American sources say that every year 20% of patients undergoing dialysis refuse further procedures. By doing so, they are essentially committing suicide because of the unbearable conditions of their lives. People suffering from end-stage renal disease cling to life if they have any hope of waiting for a kidney transplant. Or if they want to finish some business.

Kidney transplant: advantages and disadvantages

Kidney transplantation provides patients with a better quality of life and longer life than dialysis. The main thing is that the binding to the place and time of dialysis procedures disappears. Thanks to this, patients have the opportunity to work and travel. After a successful kidney transplant, dietary restrictions can be relaxed, although food should remain healthy.

The disadvantages of transplantation compared to dialysis are the surgical risks and the need to take immunosuppressant drugs that have side effects. It is impossible to predict in advance how many years the transplant will last. Despite these disadvantages, most patients choose surgery over dialysis if they have the option of obtaining a donor kidney.

The less time a patient spends on dialysis before transplantation, the better the prognosis. Ideally, surgery should be done before dialysis is needed. Kidney transplantation is performed on patients who do not have cancer and infectious diseases. The operation takes about 4 hours. During it, the patient's own filtering organs are not removed. The donor kidney is mounted in the lower part of the abdomen, as shown in the figure.

What are the features of the postoperative period?

After the operation, regular examinations and consultations with specialists are required, especially during the first year. In the first months, blood tests are taken several times a week. Further, their frequency decreases, but regular visits to a medical facility will still be needed.

Rejection of a transplanted kidney may occur despite the use of immunosuppressant medications. Its signs: fever, reduced volume of urine, swelling, pain in the kidney area. It is important to take action in time, not to miss the moment, to urgently contact the doctors.

Diabetes negatively affects the immune system, so the patient gets sick more often. Antibiotics for diabetes are used in extreme cases when antimicrobial treatment is needed. The immune barrier is reduced, so the patient's body reacts to all pathogenic viruses. The appointment of such serious drugs is done exclusively by the doctor, with disturbed metabolic processes, the effect is the opposite of what was expected or not achieved at all.

When are antibiotics used?

The body of a diabetic is vulnerable, so the infection can affect any part of the body. When diagnosing a disease, immediate intervention is required. More often, antibiotics are prescribed in the presence of such pathologies:

• dermatological diseases;
• infections in the urinary system;
• diseases of the lower respiratory tract.

First of all, the effect occurs on organs with an increased load. The kidneys do not cope with their functions by 100%, so infectious lesions can lead to nephropathy. Antibiotics and diabetes mellitus are concepts that are combined with caution. Appointment occurs in extreme cases, when there is a risk of developing hypoglycemia. The acute course of the disease should take place under the supervision of a doctor in a hospital.

Respiratory tract pathologies

Antibiotics for type 2 diabetes are prescribed according to the standard scheme. The cause is bronchitis or pneumonia. X-ray monitoring is regularly carried out, since the course of the disease is complicated by an initially weakened immune system. In the treatment, protected penicillins are used: Azithromycin, Grammidin in combination with symptomatic therapy. Before use, carefully study the instructions, pay attention to the sugar content. With high blood pressure, antibiotics with a decongestant effect are prohibited. Combine reception with probiotics and dietary supplements that preserve the microflora and prevent adverse reactions, especially in type 1 diabetics.

Skin infections

To eliminate symptoms, diabetics should pay attention to the level of sugar, as a high level prevents healing and blocks the action of antibiotics. The most common infectious diseases of the skin:

• furunculosis and carbuncle;
• necrotizing fasciitis.

diabetic foot

When treating a diabetic foot, you need to prepare for a long and painful healing process. Bleeding ulcer formations are formed on the extremities, which are divided into 2 groups of severity. For diagnosis, samples are taken from the detachable sequester, an X-ray of the foot is performed. Antibiotics for diabetic foot are prescribed topical and oral. If there is an increased risk of limb amputation, for outpatient treatment are used: "Cefalexin", "Amoxicillin". Medications can be combined with a complex course of the disease. Course treatment is carried out for 2 weeks. The therapy is carried out in a complex and consists of several stages:

• compensation for diabetes;
• reduction in the load of the lower extremities;
• regular treatment of wounds;
• limb amputation with purulent-necrotic lesions, otherwise death.

Treatment of furunculosis and fasciitis

Furunculosis and carbuncle are recurrent diseases. The inflammatory process is localized on the scalp. Occurs in violation of carbohydrate metabolism and non-compliance with a therapeutic diet, accompanied by purulent-necrotic wounds in the deep layers of the skin. Antibacterial treatment: "Oxacillin", "Amoxicillin", the course of treatment is 1-2 months.

With necrotizing fasciitis, immediate hospitalization is required, as there is a high risk of infection spreading throughout the body. The soft tissues of the shoulder, anterior thigh, and abdominal wall are affected. Treatment is carried out in a complex manner, antibiotic therapy is only an addition to surgical intervention.